Gracilis Muscle Transfer

[cbe411]

Hey guys! I am going ot see my doctor next weeke to talk about having this done for biceps function. I an not one to be scred about surgery but I am weird about even talking about this one! The thought of it scares me mad! We are only discussing the possibility of it!! I know that some of you have had this and I was wondering about what questions should I ask my doc..... Ellen anything you hnave to say here would be greatly appreciated!
Thanks!

COurt xx

[stx431]

Hey Courtney, Carrie is planning to have the same procedure done this summer. Dr Nath hasn't told us who would be the doctor that would be working with him, but Brenda is suppose to make us an appt to see him or her in January. Ellen had some good things to say about the procedure John had at Mayo. I'm interested in more post op recovery info from her when she replys to your post.

c-ya, Dick

[EllenB]

Hey Courtney,

It's great you're willing to consider the muscle transfer! I think it makes a ton of sense when transferred nerves aren't enough to get good muscle movement. I'll write a bit about John's experience & recovery, and also see what questions I can come up with.

Quick overview: for each of John’s surgeries, we saw results within 6 months. The first was for elbow movement, the second for hand grip, and there was a 7 week gap between them. The nerves transferred for the gracilis as well as original muscle innervation included:
- crosslateral C7
- phrenic
- 3 intercostals for function
- 1 intercostal for sensory – so John will know when he’s touched something with his fingers

John’s sural nerves were also used for grafting.

Original function & strength hasn’t been compromised by the transferred nerves. By that I mean that John now has full strength in the good arm from which the partial C7 was taken. The partially collapsed lung from the phrenic transfer doesn’t affect him, & he still is very active on his bike. No problems from rerouting the intercostals.

So one question would be how Dr. Nath will innervate the gracilis muscles. How many of these has he done? What timeframe & extent of recovery does he expect? Can you speak with other patients who have had this procedure done by him – both recently & longer term since their surgeries. I’m interested in what you learn – partly since his background is plastic surgery & the Mayo doctor’s is neurosurgery. Both disciplines have excellent ability to perform microsurgery, but I expect the approach might be somewhat different.

I’m sure others can add more questions & suggestions. If you haven’t yet, prepare a binder with tabs – including detailed anatomy drawings of the bp area, research articles you’ve read from the net, organized list of questions, etc. Many of us have ended up in the consultation sessions without an organized way to be sure all our questions are answered, much less remembered later! See if it’s possible to even tape record your meeting to help you review later. We’ve even begun bringing our camcorder to Mayo visits to tape the sessions with their PT person for our local therapist to see.

Finally, it’s absolutely OK to be a bit “iffy” about this. Just keep asking questions!

Take care,

Ellen


PS - We might be able to get you a VHS or DVD of John's surgery, if you are interested & think you can stomach it (smile)

[cbe411]

Thanks a bunch Ellen! i would be very i terested in seeing the actual procedure of Johns surgery! If ther ei s a way that I could see that it would be wonderful! BLood really isnt bad anymore! hehe Thanks for all of the questions too, they are going in my notebook!

COurt xx

[stx431]

Hi y'all, I talked to Dr Nath's secretary Brenda the last time we had an appt. I asked her about Dr Naths bpi/plastic surgery background. She said he never really did any plastic surgery, but he's done exclusively BPI procedures. I thought he did some plastic surgery since he usually wore a "plastic suregery dept" white coat, but maybe that dept was easy to get white coats from. I know we're in good hands. I'm going to ask him about maybe getting a former transfer patient to call or email Carrie if they would. Carrie's going for the transfer to her forearm for wrist/finger function. She had the nerve trans to her bicep, it's kicking in slow, but we see movement. It's hard to remain patient, but I guess these things take alot of time. Talk to you again soon, Dick

[jennyb]

Hi Court
more surgery? I thought I read a post ages back that your biceps was going great after your last surgery-will this one just increase what you have? Photos of you make it look like your arm is so strong, just goes to show.

I think Dr Nath is usually described as a plastic surgeon as that is what his board certification is in, he also has published some papers on plastic surgery techniques. Maybe he doesn't do those things any more, although he is still doing plastic surgery for erectile dysfunction as far as I can see, and has done for years so I don't know why Brenda would say he only does bpi work.
I don't think it matters what the doctors title is (plastic surgeron, neurosurgeon, ortho) a long as she/he has a main interest in bpi, and for me I would want that main interest to be tbpi. I also wouldn't let anyone other than an ortho or hand surgeon go near me for bone surgery.

Court, let us know what happens and if you decide to go ahead!
Jen NZ

[cbe411]

Jen, my arm is regaining some strength in the biceps BUT nothing against gravity.... its only been a year since my last op so its hard to say but Im getting impatient! Pictures look good? That makes me feel a bit better! i hav enot had to atrophy that most get with this injury Jen I really lucked out there.

Dick who will be the doc wotking with Nath on Carries procedure? I Am consulting with Dr. Gharbaoui, I think he is the main guy for this op but Im not sure. Just corious!

COurt xx

[stx431]

Hey COurt, We're suppose to have an appt with the doctor that will be working with Dr Nath on Carrie's muscle transfer prior to scheduling the surgery. Benda said she would let me know who the doctor will be and make an appt with him or her for sometime in January. I recall Dr Nath saying something about a doctor at Hermann in Houston, but nothing definitive. I'll call Brenda today and ask her if anything has come up. till next time, Dick

[stx431]

Your correct Jen, I made a mistake in saying Dr Nath does bpi work exclusively. I should have said he does them "primarily" as he does many other neuro procedures. Thanks for getting me to think.

c-ya, Dick

[stx431]

COurt, Talked to Brenda today, she said Dr Gharbaoui will be working with Dr Nath on Carries transfer this summer. Do you know his first name, I'm curious what Google or the med search engines will come up with, since there are many Dr Gharbaoui's on the net.

Dick